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1、Lancetarticle*onmedicineprices,availabilityandaffordabilityQuestionsandAnswers,January2009*CameronA,EwenM,Ross-DegnanD,BallD,LaingR.Medicineprices,availability,affordabilityin36developingandmiddle-incomecountries:secondaryanalysis.Lancet17Jan2009;373:240-249.Whatarethekeyfactsaboutmedic
2、inepricesandavailabilityreportedinthearticle?Largegapsexistintheavailabilityofmedicinesinboththepublicandprivatesectorsaswellasawidevariationinprices,muchbeyondtheinternationalreferenceprices,whichrenderessentialmedicinesunaffordabletopoorpeople.Analarmingpercentageofmedicinesareunavail
3、able,particularlyinthepublicsector:•Averageavailabilityacrosssurveyswasonly38%inthepublic-sectorand64%intheprivatesector.Lowpublicsectoravailabilityforcespatientstopayhigherpricesfromprivate-sectorsuppliers–andriskdebtorpoverty–orgowithout:•InAfrica,forexample,thelowest-paidgovernmentwo
4、rkerneedstospend2days'salaryeachmonthtopurchasediabetestreatmentusingagenericmedicine.Whentheoriginatorbrandisused,costsescalatetoover8days'wages.•Private-sectorpatientspaid9-25timesinternationalreferencepricesforlowest-pricedgenericproductsandover20timesinternationalreferencepricesforo
5、riginatorproducts.Highmedicinespricesarelargelyduetowholesaler,distributerandretailermark-ups,andwheretheyexist,governmenttaxesandduties.•Forexample,inthepublicsectorsinEthiopiaandMali,add-oncostsinthesupplychaincannearlydoublethepriceofmedicines.•Intheprivatesector,wholesalemark-upsran
6、gedfrom2%to380%,whileretailmark-upsrangedfrom10%to552%.Whatdogovernmentsneedtodotoimprovetheavailabilityofaffordableessentialmedicines?Whilepoliciesthatpromoteaccesstomedicinessuchasgenericsubstitutionareinplaceinmanycountries,additionalnationaleffortsarerequiredtoimprovetheavailability
7、andaffordabilityofmedicines.Thesemeasuresinclude:controllingsupplychaincosts,includinglimitingwholesaler,distributerandretailermark-upsandremovinggovernmentdutiesandtaxeswheretheseexist;promotingtheuseofgenericproducts;andimprovingmedicinesfinancinganddistributionefficiency.Wha
